BJUI compass最新文献

{"title":"WATER versus WATER II 5-year update: Comparing Aquablation therapy for benign prostatic hyperplasia in 30–80-cm3 and 80–150-cm3 prostates","authors":"Mohamad Baker Berjaoui,&nbsp;David-Dan Nguyen,&nbsp;Saud Almousa,&nbsp;Karim Daher,&nbsp;Neil Barber,&nbsp;Mo Bidair,&nbsp;Peter Gilling,&nbsp;Paul Anderson,&nbsp;Kevin C. Zorn,&nbsp;Gopal Badlani,&nbsp;Mitch Humphreys,&nbsp;Steven Kaplan,&nbsp;Ronald P. Kaufman Jr,&nbsp;Dean Elterman,&nbsp;Mihir Desai,&nbsp;Claus Roehrborn,&nbsp;Naeem Bhojani","doi":"10.1002/bco2.430","DOIUrl":"10.1002/bco2.430","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aims to compare the long-term outcomes of Aquablation for small-to-moderate (30–80 cm³) prostates with the outcomes for large (80–150 cm³) prostates at 5-year follow up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The Waterjet Ablation Therapy for Endoscopic Resection of Prostate Tissue (WATER; NCT02505919) is a prospective, double-blind, international clinical trial encompassing 116 patients, examining Aquablation versus transurethral resection of the prostate (TURP) for LUTS/BPH in prostates sized between 30 and 80 cm³. In parallel, WATER II (W-II; NCT03123250), a prospective, multicentre, single-arm international clinical trial, explores Aquablation outcomes in prostates ranging from 80 to 150 cm³. Baseline parameters and 60-month outcomes were scrutinized using statistical analyses, including Students' <i>t</i> test, Wilcoxon tests for continuous variables, and Fisher's test for binary variables.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There is a significant improvement in International Prostate Symptom Score (IPSS) from baseline to 60 months in both WATER (22.9 to 7.0) and WATER II (23.2 to 6.8) (<i>P</i> = 0.852). Urinary flow rate (Qmax) increased in both groups from baseline to 60 months (WATER: 9.4 to 17.3 cc/s; WATER II: 8.7 to 17.1 cc/s) (<i>P</i> = 0.933). Immediate and sustained enhancements were observed in IPSS and Qmax. At 5 years, a notable percentage of patients in both groups were BPH medication-free (WATER: 99%; WATER II: 94%) (<i>P</i> = 0.0517) and free from surgical retreatment (WATER: 95%; WATER II: 97%) (<i>P</i> = 0.508).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The 5-year follow-up affirms that Aquablation therapy exhibits sustained outcomes, minimal irreversible complications, and low retreatment rates for treating LUTS/BPH, irrespective of prostate volume ranging from 30 to 150 cm³.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 11","pages":"1023-1033"},"PeriodicalIF":1.6,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11557270/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine learning analysis for detecting late recurrence and loss to follow-up after renal cell carcinoma surgery","authors":"Kodai Sato,&nbsp;Tomokazu Sazuka,&nbsp;Takayuki Arai,&nbsp;Hiroaki Sato,&nbsp;Manato Kanesaka,&nbsp;Keisuke Ando,&nbsp;Shinpei Saito,&nbsp;Sangjon Pae,&nbsp;Yasutaka Yamada,&nbsp;Yusuke Imamura,&nbsp;Shinichi Sakamoto,&nbsp;Tomohiko Ichikawa","doi":"10.1002/bco2.425","DOIUrl":"https://doi.org/10.1002/bco2.425","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Renal cell carcinoma (RCC) is shown to have a tendency for late recurrence, occurring 5 or more years after curative surgery. Imaging diagnosis is required for follow-up, and there is no definitive answer as to how long this should continue. Some patients discontinue follow-up visits at their own discretion. How best to predict late recurrence and loss to follow-up (LF) remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and methods</h3>\u0000 \u0000 <p>This study targeted patients diagnosed with non-metastatic RCC who underwent either radical or partial nephrectomy at Chiba University Hospital between 1988 and 2021. Follow-up for patients with RCC is typically lifelong. We used random survival forests (RSFs), a machine learning-based survival analysis method, to predict late recurrence and LF. For verification of prediction accuracy, we applied the time-dependent area under the receiver operating characteristic curve (t-AUC). To analyse the risks of late recurrence and LF, SurvSHAP(t) and partial dependence plots were used.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We analysed 1051 cases in this study. Median follow-up was 58.5 (range: 0–376) months. The predictive accuracy of recurrence using RSF was t-AUC 0.806, 0.761, 0.674 and 0.566 at 60, 120, 180 and 240 months postoperatively, respectively. The recurrence risk impact showed a time-dependent increase up to approximately 50 months postoperatively. Beyond 50 months, there were no distinct risk factors characteristic of late recurrence. The predictive accuracy of LF using RSF was t-AUC 0.542, 0.699, 0.685, 0.628 and 0.674 at 60, 120, 180, 240 and 300 months postoperatively, respectively. The risk of LF increased with advancing age beyond 70 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>It is difficult to identify factors that predict late recurrence. For long-term follow-up observation, it is essential to pay particular attention to patients with RCC aged 70 years and above. Establishing frameworks to facilitate collaboration with local hospitals near patients' residences and providing care within the community is necessary.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 10","pages":"950-956"},"PeriodicalIF":1.6,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.425","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ureter-ileum-interposition: Combined experience from two high-volume centres","authors":"Maksym Pikul,&nbsp;David Pfister,&nbsp;Constantin Rieger,&nbsp;Christian Bach,&nbsp;Oleg Voylenko,&nbsp;Oleksandr Stakhovskyi,&nbsp;Sofiya Semko,&nbsp;Iurii Vitruk,&nbsp;Oleksii Kononenko,&nbsp;Eduard Stakhovsky,&nbsp;Axel Heidenreich","doi":"10.1002/bco2.434","DOIUrl":"https://doi.org/10.1002/bco2.434","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <p>The current study aimed to evaluate short- and long-term complication rates and functional outcomes in a substantial cohort of patients undergoing ileal ureter interposition at two high-volume medical centres.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and methods</h3>\u0000 \u0000 <p>A retrospective single-arm analysis was conducted on patients who underwent ureter reconstruction using ileum between 2003 and 2022 at the University Clinic of Cologne and the National Cancer Institute of Ukraine. Data on aetiology, surgical techniques, pre- and postoperative kidney function changes, readmission rates and complication management were collected. Postoperative complications were classified according to Clavien–Dindo, and estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI formula.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Results revealed 107 cases with consistent data. Within 90 days post-surgery, 53% experienced complications, mainly graded as I–II. Grade III complications were seen in 13%, with two cases of grade IV complications leading to extended hospitalisation and patient death. The 90-day mortality rate was 1.8%. Over a mean follow-up of 52 months, clinically significant vesico-renal refluxes occurred in 28%, with only 5.4% leading to persistent urinary tract infection. Antireflux techniques appeared to reduce urine upflow incidence compared with conventional interposition. Anastomosis stricture occurred in 15% of patients, with 63% requiring permanent re-stenting and 37% needing re-anastomosis. Metabolic acidosis was clinically significant in 7.5% of cases. A slight improvement in renal function was observed during the first year post-surgery (average postoperative eGFR = 76 ± 22 ml/min; Mann–Witney <i>U</i> test, <i>p</i> = 0,0198). Affected kidney function improved in 56 (52%), was stable in 41 (38%) and deteriorated in 10 (9.3%). Loss of kidney function on the surgery side was seen in 4 (3.7%) patients and resulted in nephrectomy in 3 (2.8%) cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Ileal ureter interposition demonstrated a favourable safety profile and functional outcomes. This surgical intervention provides an effective tension-free bypass, irrespective of healthy ureter length.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 10","pages":"924-933"},"PeriodicalIF":1.6,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.434","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sleep and health improvement programme (SHIP) for patients with prostate cancer and caregivers","authors":"Stacy Loeb,&nbsp;Rebecca Robbins,&nbsp;Tatiana Sanchez-Nolasco,&nbsp;Nataliya Byrne,&nbsp;Andrea Ruan,&nbsp;Adrian Rivera,&nbsp;Natasha Gupta,&nbsp;Stacey A. Kenfield,&nbsp;June M. Chan,&nbsp;Erin L. Van Blarigan,&nbsp;Patricia Carter,&nbsp;Girardin Jean-Louis,&nbsp;Stephanie L. Orstad","doi":"10.1002/bco2.435","DOIUrl":"https://doi.org/10.1002/bco2.435","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The objective of this study is to determine whether a sleep and health improvement programme (SHIP) to promote healthy sleep, eating and physical activity would be feasible, acceptable and have a positive impact on lifestyle behaviours for prostate cancer survivors and caregivers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We recruited 50 participants for a single group 3-month pre-post pilot study. The SHIP intervention included (1) website about sleep, nutrition and physical activity (≥1 view/week), (2) two email newsletters with goal-setting exercises and resources and (3) midpoint health coach call. The primary outcome was changes in validated sleep scales; secondary outcomes included changes in diet, physical activity and concentration from baseline to 3 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 50 participants enrolled, median age was 65, 30% were Black and 8% were Hispanic. Thirty-four patients and 7 family caregivers completed the pilot study (82%). Following the intervention, we observed a statistically significant improvement in the Sleep Hygiene Index (pre: 15, post: 13, <i>p</i> &lt; 0.01), and a trend toward lower Insomnia Severity Index (pre: 12, post: 9, <i>p</i> = 0.07). There were no statistically significant improvements in sleep quality or physical activity, but there were improvements in healthy eating (e.g., increase in cruciferous vegetables and reduction in dairy) and in fatigue-related problems and concentration. Exit interview feedback was positive.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A web-based sleep and healthy lifestyle programme for patients with prostate cancer and their caregivers is feasible and acceptable. A randomized controlled trial is planned to test whether a refined SHIP improves sleep and lifestyle in patients with prostate cancer and caregivers.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 10","pages":"976-985"},"PeriodicalIF":1.6,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.435","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Mayo Adhesive Probability score and BMI on renal functional decline after robotic assisted partial nephrectomy","authors":"Cesare Saitta,&nbsp;Marco Paciotti,&nbsp;Giovanni Lughezzani,&nbsp;Giuseppe Garofano,&nbsp;Margaret F. Meagher,&nbsp;Kit L. Yuen,&nbsp;Vittorio Fasulo,&nbsp;Roberto Contieri,&nbsp;Pier Paolo Avolio,&nbsp;Andrea Piccolini,&nbsp;Paola Arena,&nbsp;Matilde Mantovani,&nbsp;Edoardo Beatrici,&nbsp;Marta Calatroni,&nbsp;Francesco Reggiani,&nbsp;Rodolfo F. Hurle,&nbsp;Massimo Lazzeri,&nbsp;Alberto Saita,&nbsp;Paolo Casale,&nbsp;Ithaar H. Derweesh,&nbsp;Nicolò M. Buffi","doi":"10.1002/bco2.417","DOIUrl":"https://doi.org/10.1002/bco2.417","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The purpose of this study is to investigate the impact of Mayo Adhesive Probability (MAP) score and body mass index (BMI) on renal function decline after robotic assisted partial nephrectomy (RAPN).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We queried our prospective database for patients who underwent RAPN between January 2018 and December 2023. Outcomes were development of de novo CKD-S3 (estimated glomerular filtration rate [eGFR] &lt; 60 ml/min/1.73 m²). Multivariable analysis (MVA) via Cox regression identified predictors for CKD-S3. Kaplan–Meier Analyses was fitted for survival assessment. Finally, multivariable linear regression was utilized to identify predictors of delta eGFR at last follow-up (preoperative eGFR—last eGFR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Two-hundred fifty-eight patients were analysed (obese <i>n</i> = 49 [19%]; MAP score 0–2 = 135 [52.33%]; MAP score 3–5 = 123 [47.6%]) with a median follow-up of 33 (IQR 20–42) months. MVA revealed, high MAP score (HR 2.29, <i>p</i> = 0.019), increasing RENAL score (HR 1.26, <i>p</i> = 0.009), increasing age (HR 1.04, <i>p</i> = 0.003), obesity (HR 2.38, <i>p</i> = 0.006) and diabetes mellitus (HR 2.38, <i>p</i> = 0.005) as associated with increased risk of development of CKD-S3, while trifecta achievement was not (<i>p</i> = 0.63). Comparing low MAP score versus high MAP score 4-year CKD-S3 free survival was 87.8% versus 56.1% (<i>p</i> &lt; 0.001). Multivariable linear regression showed that high MAP score (coefficient 6.64, <i>p</i> = 0.001) and BMI (coefficient 0.51, <i>p</i> = 0.011) were significantly associated with increased delta eGFR at last follow up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>MAP score and increasing BMI are predictor for long term renal functional detrimental. These insights may call consideration for closer follow-up or greater medical scrutiny prior surgery in obese patients and with elevated MAP score. Further investigations are requisite.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 10","pages":"942-949"},"PeriodicalIF":1.6,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.417","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MR-Linac-guided stereotactic radiotherapy for CT-indiscernible intravascular renal cell carcinoma tumours","authors":"Mihir D. Shanker,&nbsp;Zhiqian Henry Yu,&nbsp;Jinzhong Yang,&nbsp;Surena Matin,&nbsp;Matthew T. Campbell,&nbsp;Pavlos Msaouel,&nbsp;Nizar Tannir,&nbsp;Surendra Prajapati,&nbsp;Yao Ding,&nbsp;Belinda Lee,&nbsp;Angela Sobremonte,&nbsp;Chad Tang","doi":"10.1002/bco2.428","DOIUrl":"https://doi.org/10.1002/bco2.428","url":null,"abstract":"&lt;p&gt;Inferior vena cava tumour thrombus (IVC-TT) is a life-threatening complication of advanced renal cell carcinoma (RCC) occurring in 10%–25% of patients with RCC with one third of patients having concurrent distant metastatic disease.&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt; Surgical resection in the form of radical nephrectomy and caval thrombectomy is the established option for obtaining local control of the disease and is associated with long-term oncologic control; however, only 50% of patients are operative candidates at time of diagnosis.&lt;span&gt;&lt;sup&gt;3, 4&lt;/sup&gt;&lt;/span&gt; Untreated RCC IVC-TT has a poor natural history, with a median survival of 5 months with a 1-year disease-specific survival of 29%.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; Stereotactic ablative body radiotherapy (SBRT) is a potentially feasible and safe option in patients who are not surgical candidates with the potential to be used for a wide range of RCC indications, from definitive local control in inoperable candidates, advanced-stage disease palliation and to improve survival outcomes in oligometastatic settings. However, renal disease-restricted contrast use and poor visualization of RCC IVC-TT with conventional computed tomography (CT) impairs precise planning and treatment delivery. Magnetic resonance linear accelerator (MR-Linac)-based therapy is a novel technology, which allows advanced visualization of thrombi targets for improved delineation, inter- and intra-fraction monitoring and adaptive treatment.&lt;/p&gt;&lt;p&gt;We report the world-first use of this approach in five patients treated at a major North American cancer centre. Patient, tumour, and treatment characteristics, toxicity, and local control outcomes of IVC-TT patients treated with a 1.5 T MR-Linac at the University of Texas MD Anderson Cancer Center were retrospectively evaluated. Patients received 40–50 Gy in five fractions over 2 weeks. Planning tumour volume (PTV) (uncertainty) margins were 3–7 mm anisotropically. Plans were generated in Monaco treatment planning system (v5.40, Elekta Solutions AB, Stockholm, Sweden). Primary outcomes were local control, radiological response as per the Response Evaluation Criteria in Solid Tumours (RECIST) 1.1 through follow-up imaging, composite clinical/biochemical palliation outcomes and toxicity.&lt;/p&gt;&lt;p&gt;The median age was 52 years (interquartile range [IQR] 45–56), and median follow-up was 11.1 months (IQR 8.9–12.2). Sixty percent of patients had a Mayo Level III IVC, with two patients having a level IV extension. The median tumour volume was 12.8 cc (IQR 4.4–22.9). One patient had symptomatic lower limb edema and abdominal pain, and one other patient had deranged liver function parameters prior to treatment. During treatment planning, visualization of the tumour-IVC interface was indiscernible with standard diagnostic non-contrast CT but visualized with MR-based simulation and during treatment using MR guidance, which permitted radiotherapy dose escalation to maximize local control (Figure 1). Intra","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 10","pages":"913-915"},"PeriodicalIF":1.6,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.428","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical application values of a novel synthetic training simulator for bulbar urethral anastomosis","authors":"Jing-Dong Xue,&nbsp;Ping Zhang,&nbsp;Yue-Min Xu,&nbsp;Ying-Long Sa,&nbsp;Hui-Quan Shu,&nbsp;Lin Wang,&nbsp;Hong Xie,&nbsp;Chao Li,&nbsp;Wei Zhang,&nbsp;Chao Feng,&nbsp;Deng-Long Wu","doi":"10.1002/bco2.426","DOIUrl":"https://doi.org/10.1002/bco2.426","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This study aimed to report a newly developed, high-fidelity synthetic simulator to simulate excision and primary anastomotic (EPA) bulbar urethroplasty and its clinical use for new practitioners in shortening the learning curve.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>The bulbar urethral anastomosis simulator consists of several standardized components created according to the actual size of the male patient. Interns, novice residents, and fellows inexperienced with urethral reconstruction (<i>n</i> = 10, 5, 5) from different medical centres were invited to participate in the training programme. Two reconstructive urology experts monitored each practice. Following the training, three kinds of validity testing were used to assess the simulator: face, content, and construct. In the intern group, the task performance in the first five training sessions and the last five training ones were compared using a self-control approach. In the resident and fellow group, the real surgical data, including estimated blood loss, operative duration, and 6-month post-operative success rate of trainees after training, are plotted, which are compared with that of reconstructive urology experts (<i>n</i> = 5) included retrospectively to study the effectiveness of the simulator in shortening the learning curve.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The overall mean satisfaction rate for the simulators was inspiring and evaluated by experts. In the intern group, significant improvement can be achieved through 10 training sessions (<i>p</i> &lt; 0.05). In clinical practice, the intraoperative indicators and surgical success rate of both the training groups showed the tendency to close or even better than those in the expert group. In terms of the learning curve, training groups performed better compared with experts in the early stages of their careers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In conclusion, this synthetic training simulator for bulbar urethral anastomosis is novel, effective, and convenient for beginners of different groups. The training course can bridge the gap between preclinical use and actual surgery via this simulator.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 10","pages":"916-923"},"PeriodicalIF":1.6,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.426","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extracapsular extension risk assessment using an artificial intelligence prostate cancer mapping algorithm","authors":"Alan Priester,&nbsp;Sakina Mohammed Mota,&nbsp;Kyla P. Grunden,&nbsp;Joshua Shubert,&nbsp;Shannon Richardson,&nbsp;Anthony Sisk,&nbsp;Ely R. Felker,&nbsp;James Sayre,&nbsp;Leonard S. Marks,&nbsp;Shyam Natarajan,&nbsp;Wayne G. Brisbane","doi":"10.1002/bco2.421","DOIUrl":"https://doi.org/10.1002/bco2.421","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The objective of this study is to compare detection rates of extracapsular extension (ECE) of prostate cancer (PCa) using artificial intelligence (AI)-generated cancer maps versus MRI and conventional nomograms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and methods</h3>\u0000 \u0000 <p>We retrospectively analysed data from 147 patients who received MRI-targeted biopsy and subsequent radical prostatectomy between September 2016 and May 2022. AI-based software cleared by the United States Food and Drug Administration (Unfold AI, Avenda Health) was used to map 3D cancer probability and estimate ECE risk. Conventional ECE predictors including MRI Likert scores, capsular contact length of MRI-visible lesions, PSMA T stage, Partin tables, and the “PRedicting ExtraCapsular Extension” nomogram were used for comparison.</p>\u0000 \u0000 <p>Postsurgical specimens were processed using whole-mount histopathology sectioning, and a genitourinary pathologist assessed each quadrant for ECE presence. ECE predictors were then evaluated on the patient (Unfold AI versus all comparators) and quadrant level (Unfold AI versus MRI Likert score). Receiver operator characteristic curves were generated and compared using DeLong's test.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Unfold AI had a significantly higher area under the curve (AUC = 0.81) than other predictors for patient-level ECE prediction. Unfold AI achieved 68% sensitivity, 78% specificity, 71% positive predictive value, and 75% negative predictive value. At the quadrant level, Unfold AI exceeded the AUC of MRI Likert scores for posterior (0.89 versus 0.82, <i>p</i> = 0.003), anterior (0.84 versus 0.80, <i>p</i> = 0.34), and all quadrants (0.89 versus 0.82, <i>p</i> = 0.002). The false negative rate of Unfold AI was lower than MRI in both the anterior (−60%) and posterior prostate (−40%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Unfold AI accurately predicted ECE risk, outperforming conventional methodologies. It notably improved ECE prediction over MRI in posterior quadrants, with the potential to inform nerve-spare technique and prevent positive margins. By enhancing PCa staging and risk stratification, AI-based cancer mapping may lead to better oncological and functional outcomes for patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 10","pages":"986-997"},"PeriodicalIF":1.6,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.421","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National audit of patient reported experience of radical cystectomy for bladder cancer pathways","authors":"Preksha Kuppanda,&nbsp;Louisa Hermans,&nbsp;Alan Uren,&nbsp;Nikki Cotterill,&nbsp;Edward Rowe,&nbsp;Krishna Narahari,&nbsp;Andrew Dickinson,&nbsp;Jeannie Rigby,&nbsp;Jonathan Aning,&nbsp;C-PAT Study Group (#) and the BAUS Section of Oncology","doi":"10.1002/bco2.422","DOIUrl":"https://doi.org/10.1002/bco2.422","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The objective of this study was to measure and describe the national patient experience of radical cystectomy (RC) pathways in the UK using the validated Cystectomy-Pathway Assessment Tool (C-PAT).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>A cohort of 1081 patients who underwent RC for bladder cancer, between 1 January 2021 and 31 July 2022 at 33 UK cystectomy centres, returned completed C-PAT responses. SPSS was employed for data summary statistics, including median, interquartile range, Mann Whitney U test or Chi-square test with a 95% confidence interval to assess statistical significance between potentially associated variables. Open-text responses in the C-PAT tool were analysed and coded using NVivo software.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In this cohort, the greatest perceived delay in the RC pathway, reported by 19% of patients (<i>n</i> = 208), was at the GP consultation to first hospital referral stage with suspected bladder cancer. Around 10% of patients perceived delays at each of the other stages in their pathway. Cancer nurse specialist (CNS) contact was strongly associated with an improved patient experience (<i>p</i> &lt; 0.001); however, 9.5% of patients reported that they were not assigned a cancer nurse specialist in their pathway. Overall, 96% (<i>n</i> = 1028) reported their experience of RC pathway care to be good or excellent. There were no significant differences in reported patient experience found between cystectomy centres.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This audit demonstrates the feasibility of measuring patient experience of RC pathways at scale. The C-PAT tool demonstrated utility in identifying specific pathway areas for quality improvement. Overall UK patients report a high quality pathway experience. A focus on improving the referral pathway between primary and secondary care is necessary.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 10","pages":"961-968"},"PeriodicalIF":1.6,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.422","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of immune checkpoint inhibitor combination therapy prior to nephrectomy in advanced renal cell carcinoma: A retrospective pilot study","authors":"Sho Kiyota,&nbsp;Takashi Yoshida,&nbsp;Takahiro Nakamoto,&nbsp;Eri Jino,&nbsp;Takao Mishima,&nbsp;Hidefumi Kinoshita","doi":"10.1002/bco2.419","DOIUrl":"https://doi.org/10.1002/bco2.419","url":null,"abstract":"<p>Renal cell carcinoma (RCC) affects 10%–20% of patients annually, often with metastases present. This study evaluated the impact of systemic therapy before nephrectomy in patients with unresectable or metastatic renal cell carcinoma (RCC). Patients receiving upfront immune checkpoint inhibitor (ICI) combination therapy showed significantly improved progression-free survival (PFS) compared to nephrectomy alone (2-year PFS: 62.3% vs. 17.4%; <i>p</i> = 0.036), while upfront tyrosine kinase inhibitor (TKI) therapy did not (2-year PFS: 18.2% vs. 12.3%; <i>p</i> = 0.545). Surgery-related outcomes did not differ significantly between groups. ICI therapy maintained tumour reduction rates better than TKI therapy. The study highlights the potential benefits of ICI combination therapy over TKI therapy in advanced RCC, suggesting further research is needed to confirm these findings.</p>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 10","pages":"957-960"},"PeriodicalIF":1.6,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.419","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}